Senate Bill 1160 introduced sweeping reform to workers’ compensation. Here’s a close look at the bill’s impact when you treat an applicant on a lien basis.
Frequently Asked Question
Q: What happens when you treat an applicant on a lien basis?
A: In order to file the lien, you must have documented evidence that the employer neglected or unreasonably refused the necessary treatment to the injured employee.
Section 8 of Senate Bill 1160 amends Labor Code 4903.05 to read as follows:
“For liens filed on or after January 1, 2017, any lien claim for expenses under subdivision (b) of Section 4903 that is subject to a filing fee under this section shall be accompanied at the time of filing by a declaration stating, under penalty of perjury, that the dispute is not subject to an independent bill review and independent medical review under Sections 4603.6 and 4610.5, respectively, that the lien claimant satisfies one of the following:
a. Is the employee’s treating physician providing care through a medical provider network
b. Is the agreed medical evaluator or qualified medical evaluator.
c. Has provided treatment authorized by the employer or claims administrator under Section 4610.
d. Has made a diligent search and determined that the employer does not have a medical provider network in place.
e. Has documentation that medical treatment has been neglected or unreasonably refused to the employee as provided by Section 4600.
f. Can show that the expense was incurred for an emergency medical condition, as defined by subdivision (b) of Section 1317.1 of the Health and Safety Code.
g. Is a certified interpreter rendering services during a medical-legal examination, a copy service providing medical-legal services, or has an expense allowed as a lien under rules adopted by the administrative director.”
The key is obtaining the documented evidence. Remember – even when liability is disputed, you must still submit RFAs for the proposed treatment. From SB 1160, Section 3.5, which amends Labor Code 4610.:
“Unless otherwise indicated in this section, a physician providing treatment under Section 4600 shall send any request for authorization for medical treatment, with supporting documentation, to the claims administrator for the employer, insurer, or other entity according to rules adopted by the administrative director.”
On the date that the claims administrator’s liability becomes final, a claims administrator must conduct retrospective utilization review for all previously deferred RFAs submitted by requesting physicians. Requesting physicians do not need to resubmit their deferred RFAs to the claims administrator.
If the utilization review denies treatment, the claims administrator must issue written communication to the physician denying the requested services. The retrospective written denial provides you with documented evidence that the employer neglected or unreasonably refused the necessary treatment to the injured employee.
Webinar: Senate Bills 1160 and 1175